Treatment of patients with stage IV endometrial cancer is dictated by the site of metastatic disease and symptoms related to disease sites. For bulky pelvic disease, radiation therapy consisting of a combination of intracavitary and external-beam radiation therapy is used. When distant metastases, especially pulmonary metastases, are present, hormonal therapy is indicated and useful. Observational studies support maximal cytoreductive surgery for patients with stage IV disease, although these conclusions need to be interpreted with care because of the small number of cases and likely selection bias.
Every woman should have a regular pelvic exam and Pap test, which tests a cervical cell sample for abnormalities. Together, these procedures detect cervical cancer 95% of the time, often long before the disease produces symptoms.
If your Pap test is abnormal, your doctor may test you again. Recently, some doctors have started to test for HPV at the time of Pap smear. If a high-risk type of HPV is found in women with an abnormal Pap test, doctors are more inclined to do a colposcopy (magnified exam...
When possible, patients with stage IV endometrial cancer are treated with surgery, followed by chemotherapy, or radiation therapy, or both. For many years, radiation therapy was the standard adjuvant treatment for patients with endometrial cancer. However, several randomized trials have confirmed improved survival when adjuvant chemotherapy is used instead of radiation therapy. In a trial conducted in a subset of patients with stage III or IV disease with residual tumors smaller than 2 cm and no parenchymal organ involvement, the use of the combination of cisplatin and doxorubicin resulted in improved overall survival (OS) compared with whole-abdominal radiation therapy (adjusted hazard ratio, 0.68; 95% confidence interval limits, 0.52–0.89; P = .02; 5-year survival rates of 55% vs. 42%).[Level of evidence: 1iiA]
In a subsequent trial, paclitaxel with doxorubicin had an outcome similar to that of cisplatin with doxorubicin.[2,3] The three-drug regimen (doxorubicin, cisplatin, and paclitaxel) with granulocyte colony-stimulating factor (G-CSF), however, was significantly superior to cisplatin plus doxorubicin: response rates were 57% versus 34%; progression-free survival was 8.3 months versus 5.3 months; and OS was 15.3 months versus 12.3 months, respectively. The superior regimen was associated with a 12% grade 3 and a 27% grade 2 peripheral neuropathy.[2,3][Level of evidence: 1iiDiv]
Given the toxicity and limited efficacy of these regimens, other treatment options have been widely sought. Several observational studies [4,5] and phase II studies [6,7,8,9] suggested clinical activity with the combination of platinums and paclitaxel in endometrial cancer patients with measurable disease either following primary surgery or at recurrence. As a result, the Gynecologic Oncology Group (GOG) opened protocol GOG-0209, a noninferiority trial comparing the combination of doxorubicin, cisplatin, and paclitaxel (TAP) and G-CSF with carboplatin and paclitaxel. The interim results, currently available in abstract form, showing that carboplatin and paclitaxel is not inferior to TAP have lent credence to the use of carboplatin and paclitaxel as the standard for adjuvant treatment in stage III and IV disease.